HomeMy WebLinkAbout109420 HYDRO CONSTRUCTION CO INC - INSURANCE CERTIFICATE (26)ACORD-M CERTIFICATE OF LIABILITY INSURANCE
DATE. VY)
/OB
PRODUCER 1-303-534-4567
INA of Colorado, Inc.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Suit 1street
Suite 00
600
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver, CO 80202
INSURERS AFFORDING COVERAGE
INSURED
Hydro Construction Company, Inc.
INSURER A: American Guarantee & Liab. (Zurich American Ins)
INSURER s: American Guarantee & Liab. (Zurich N. American Ina)
301 East Lincoln Avenue
INSURER C:Pinnacol Assurance
INSURER D:
Fort Collins, CO 80524
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR NSq
rypE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
A
GENERAL LIABILITY
CP0343758104
09/30/08
09/30/09
EACH OCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMSMADE IXIOCCUR
FIRE DAMAGE (Anyone fire)
$300,000
MED EXP (An one person)
$10,000
X PD Ded:$5,000
PERSONAL &ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE
POLICY
LIMIT APPLIES PER:
1 X PPP X LOD
PRODUCTS - COMP/OP ADS
$2,000,000
A
AUTOMOBILE
LIABILITY
CP0343758104
09/30/08
09/30/09
X
ANY AUTO
a accciden) SINGLE LIMIT
(E
$ 1, 000, 000
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILYINJURY
(Perrper person)
$
X
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
B
EXCESS LIABILITY
X OCCUR CLAIMS MADE
AUC593964000
09/30/08
09/30/09
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
DEDUCTIBLE
X RETENTION $0
$
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
2091550
04/01/08
04/01/09
X WCYTATU OTH-
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$1, 000, 000
E.L. DISEASE -POLICY LIMIT I
$1, 000, 000
OTHER
S
S
S
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: DWRF Odor Control Covers Procurement.
of Fort Collins
300 W. LaPorte Ave.
Fort Collins, CO 80522-0000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
USA
crunderwood L ✓!� Q
10026852
IFtmm
ACORD-M CERTIFICATE OF LIABILITY INSURANCE
DATE. VY)
/OB
PRODUCER 1-303-534-4567
INA of Colorado, Inc.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Suit 1street
Suite 00
600
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver, CO 80202
INSURERS AFFORDING COVERAGE
INSURED
Hydro Construction Company, Inc.
INSURER A: American Guarantee & Liab. (Zurich American Ins)
INSURER s: American Guarantee & Liab. (Zurich N. American Ina)
301 East Lincoln Avenue
INSURER C:Pinnacol Assurance
INSURER D:
Fort Collins, CO 80524
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR NSq
rypE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
A
GENERAL LIABILITY
CP0343758104
09/30/08
09/30/09
EACH OCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMSMADE IXIOCCUR
FIRE DAMAGE (Anyone fire)
$300,000
MED EXP (An one person)
$10,000
X PD Ded:$5,000
PERSONAL &ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE
POLICY
LIMIT APPLIES PER:
1 X PPP X LOD
PRODUCTS - COMP/OP ADS
$2,000,000
A
AUTOMOBILE
LIABILITY
CP0343758104
09/30/08
09/30/09
X
ANY AUTO
a accciden) SINGLE LIMIT
(E
$ 1, 000, 000
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILYINJURY
(Perrper person)
$
X
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
B
EXCESS LIABILITY
X OCCUR CLAIMS MADE
AUC593964000
09/30/08
09/30/09
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
DEDUCTIBLE
X RETENTION $0
$
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
2091550
04/01/08
04/01/09
X WCYTATU OTH-
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$1, 000, 000
E.L. DISEASE -POLICY LIMIT I
$1, 000, 000
OTHER
S
S
S
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: DWRF Odor Control Covers Procurement.
of Fort Collins
300 W. LaPorte Ave.
Fort Collins, CO 80522-0000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
USA
crunderwood L ✓!� Q
10026852
IFtmm
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
25-S
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
25-S
AA -COS. CERTIFICATE OF LIABILITY INSURANCE
DAT08108DVV)
10/08/08
'-PRODUCER 1-303-534-4567
IMA of Colorado, Inc.
1550 17th Street
Suite 60o
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
Denver, CO 80202
INSURED
Hydro Construction Company, Inc.
INSURER A: American Guarantee & Liab. (Zurich American Ina)
301 East Lincoln Avenue
INSURERB: American Guarantee & Liab. (Zurich N. American Ins)
INSURER C: Pinnacol Assurance
Fort Collins, CO 80524
INSURER D:
INSURER E:
cnvconr_oc
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSfl TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION
POLICY NUMBER
DATE (MWDDNYI
A GENERAL LIABILITY CP0343758104 09/30/08 09/30/09
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE D OCCUR
X PD Ded:$5,000
LIMITS
EACH OCCURRENCE $ 1, 000, 000
FIRED AMAGE(An one fire) $ 3 0 0 , 000
MED EXP (Any one person) $ 10,000
PERSONAL& ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PRO' 51 LOG
PRODUCTS - COMP/OP AGG
$2,000,000
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
CP0343758104
09/30/08
09/30/09
COMBINED SINGLE LIMIT
(Ea accident)
$1, 0001000
_
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
X
HIREDAUTOS
X
NON OWNED AUTOS
BODILY INJURY
(Per accident)
$
P ROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
-
OTHER THAN EA ACC
$
$
AUTO ONLY: AGG
e
EXCESS LIABILITY
X OCCUR CLAIMS MADE
AUC593964000
09/30/08
09/30/09
EACH OCCURRENCE
$ 1, 000, 000
AGGREGATE
$ 1,000,000
$
DEDUCTIBLE
X RETENTION $ 0
$
C
EMPLOY WORKERSCOMPENSATIONON AND
EMPLOVERS' LIABILITY
2091550
04/01/08
04/01/09
X WC STATU- DTH-
T
E.L. EACH ACCIDENT
$ 1, 000, 000
E.L. DISEASE - EA EMPLOYE-
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
OTHER
5
S
S
DESCRIPTION OF OPERATIONS/LOCATIONSNENICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
City of Fort Collins is included as Additional Insured on the General Liability Policy if required by written contract
or agreement and with respect to work performed by Insured subject to the policy terms and conditions.
CFGTIrl! ATC UnI nco 11 .--._._..
City of Fort Collins
300 W. LaPorte Ave.
Fort Collins, CO 80522-0000
I USA
ACORD 25-S (7/97) crunderwood
innocRcc
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
❑e
AA -COS. CERTIFICATE OF LIABILITY INSURANCE
DAT08108DVV)
10/08/08
'-PRODUCER 1-303-534-4567
IMA of Colorado, Inc.
1550 17th Street
Suite 60o
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
Denver, CO 80202
INSURED
Hydro Construction Company, Inc.
INSURER A: American Guarantee & Liab. (Zurich American Ina)
301 East Lincoln Avenue
INSURERB: American Guarantee & Liab. (Zurich N. American Ins)
INSURER C: Pinnacol Assurance
Fort Collins, CO 80524
INSURER D:
INSURER E:
cnvconr_oc
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSfl TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION
POLICY NUMBER
DATE (MWDDNYI
A GENERAL LIABILITY CP0343758104 09/30/08 09/30/09
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE D OCCUR
X PD Ded:$5,000
LIMITS
EACH OCCURRENCE $ 1, 000, 000
FIRED AMAGE(An one fire) $ 3 0 0 , 000
MED EXP (Any one person) $ 10,000
PERSONAL& ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PRO' 51 LOG
PRODUCTS - COMP/OP AGG
$2,000,000
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
CP0343758104
09/30/08
09/30/09
COMBINED SINGLE LIMIT
(Ea accident)
$1, 0001000
_
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
X
HIREDAUTOS
X
NON OWNED AUTOS
BODILY INJURY
(Per accident)
$
P ROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
-
OTHER THAN EA ACC
$
$
AUTO ONLY: AGG
e
EXCESS LIABILITY
X OCCUR CLAIMS MADE
AUC593964000
09/30/08
09/30/09
EACH OCCURRENCE
$ 1, 000, 000
AGGREGATE
$ 1,000,000
$
DEDUCTIBLE
X RETENTION $ 0
$
C
EMPLOY WORKERSCOMPENSATIONON AND
EMPLOVERS' LIABILITY
2091550
04/01/08
04/01/09
X WC STATU- DTH-
T
E.L. EACH ACCIDENT
$ 1, 000, 000
E.L. DISEASE - EA EMPLOYE-
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
OTHER
5
S
S
DESCRIPTION OF OPERATIONS/LOCATIONSNENICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
City of Fort Collins is included as Additional Insured on the General Liability Policy if required by written contract
or agreement and with respect to work performed by Insured subject to the policy terms and conditions.
CFGTIrl! ATC UnI nco 11 .--._._..
City of Fort Collins
300 W. LaPorte Ave.
Fort Collins, CO 80522-0000
I USA
ACORD 25-S (7/97) crunderwood
innocRcc
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
❑e
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.